⚡ Electrolyte Disturbances · Sodium · Potassium · Calcium · Acid‑base Tool

Schwartz Clinical Handbook — Chapter 32 · Hyper/hyponatremia · Hyper/hypokalemia · Calcium disorders · Metabolic acidosis/alkalosis · ECG changes

Select symptoms (neurologic, cardiac, neuromuscular), volume status, and risk factors → generate differential for sodium, potassium, calcium, and acid‑base disorders, with emergent interventions (IV fluids, calcium, insulin/glucose, bicarbonate).
⚠️ Red flags: QTc prolongation, wide QRS, arrhythmia, altered mental status → treat immediately (calcium gluconate for hyperkalemia, hypertonic saline for severe hyponatremia with seizures).

📋 Step 1 — Clinical & ECG clues
📌 Diagnostic impressions
📖 Schwartz Ch 32

Select neurologic status (irritability, coma, seizure), cardiac (QT, QRS width, rhythm), neuromuscular (weakness, tetany, cramps), volume status, and risk factors → system identifies hyper/hyponatremia, hyper/hypokalemia, hypo/hypercalcemia, and metabolic acidosis/alkalosis, and recommends immediate interventions (dextrose, calcium, insulin, sodium correction).

✔️ Hyperkalemia: peaked T, wide QRS → calcium gluconate, insulin/glucose, albuterol.
✔️ Hypokalemia: U waves, weakness → IV/PO potassium.
✔️ Hypernatremia: dehydrated, seizures → replace free water slowly (0.5 mEq/L/h).
✔️ Hypocalcemia: prolonged QT, tetany → IV calcium gluconate.
📘 Schwartz pearls (Chapter 32)
• Anion gap metabolic acidosis → MUD PILES (methanol, uremia, DKA, propylene, iron, lactate, ethanol, salicylates).
• Hypoglycemia in ⅓ of moderate dehydration → check glucose.
• Rapid correction of hyponatremia → central pontine myelinolysis.
• Rule of 50 for dextrose: 50 / dextrose% = mL/kg for 0.5 g/kg.